Small Bowel Obstruction After Vaginal Hysterectomy with Bilateral Salpingo-oophorectomy

Abstract

Background: Removal of adnexa at the time of vaginal hysterectomy (VH) is a feasible procedure in properly selected patients. Small bowel obstruction was not found to be reported as a complication of this procedure. Case: A 61-year-old woman underwent a VH with bilateral salpingo-oophorectomy (BSO) for persistent cervical intraepithelial neoplasia grade 3. On postoperative day 7 she presented with small bowel obstruction that did not resolve with conservative management. During the repeat operation, a hematoma was visualized at the right pelvic side wall where ovarian vessels had been ligated with adhesion to the terminal ileum. Results: The small bowel stuck to the hematoma was released, and the patient underwent an appendectomy. The dilated small bowel was emptied into the stomach and aspirated via nasogastric tube. The patient tolerated the procedure and had an uneventful postoperative course. Conclusions: Small bowel obstruction is a rare complication of VH with BSO, but can occur in association with hematoma formation on the pelvic side wall at the time of the surgery. (J GYNECOL SURG 28:372)